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Friday, January 25, 2013

If online learning is the answer, then what is the question?

I have written about massive open online courses (MOOCs) before, once wondering whether disruptive innovation was finally coming to higher education and then further noting that a colleague was creating a MOOC from the materials of the ONC Health IT Curriculum. (I am pleased to report that the MOOC is making good progress.)

MOOCs also have attained quite a bit of discussion as part or all of the solution to the problem of runaway costs of higher education in the United States. The New York Times has called this year the Year of the MOOC, while others wonder if this is finally the time that Silicon Valley-style disruptive innovation will come to higher education.

I have skin in this game in a number of ways. One is that I direct a large graduate program in a public health science university that has minimal government financial support, i.e., the program is mostly dependent on tuition, training grants, and other sources of funding. This graduate program is in an academic department that I chair that is likewise being asked to achieve increasing fiscal self-sufficiency in all its activities.

I am also reaching the end of a well-funded project to develop a health information technology (HIT) curriculum for colleges and universities. In addition, I am the parent of two children, one of whom recently completed a bachelor's degree and the other who is still in undergraduate studies but planning further education beyond her bachelor's degree, both in public state universities. And of course, I am a U.S. citizen concerned about my country's long-term fiscal solvency while maintaining economic competitiveness through a highly educated populace.

To some, MOOCs are seen as a way to reduce the costs of higher education, which is under increasing scrutiny to demonstrate its value. Based on my own experience with distance learning, I am optimistic that online education can be efficient and scalable. Although I do not find myself in agreement with many of the political positions of Texas Gov. Rick Perry, I admit to having sympathy for his challenge to higher education to create a $10,000 bachelor's degree.

That said, I recognize that online courses alone do not an education make, especially a college education. College is also about maturation, participating in non-academic activities, and developing skills beyond just mastering of knowledge, such as leadership, mentorship, volunteerism, and more. I have no doubt that MOOCs can replace the kind of large lecture classes I took as an undergraduate at the University of Illinois, i.e., the "101" classes. But I am less convinced they can replace the smaller courses, the hands-on experiences, the volunteer activities, and so forth.

As enthusiastic as I am about the use of educational technology, I do not see online courses alone comprising the entire educational experience. Even in our online graduate program, we encourage networking and participation in professional organizations among our students. We have created a practicum and internship program that allows even our remote students to get real-world experience. A "distance education" in our program is not just a succession of online courses. Our students are engaged in a virtual community with us.

At the same time, I also worry that low-cost college education may create a two-class system, one of children of parents with the means to afford a four-year in-residence college education and all of its benefits, and the other of students whose college experience is mostly impersonal. I believe we need a balance.

Another interesting aspect about MOOCs and other online repositories of educational materials is the notion of "openness." I was prodded into thinking about this by some from the Office of the National Coordinator for Health IT (ONC) who want to see the curriculum be maintained in some open, perhaps crowdsourcing, project. This made me realize that MOOCs and similar initiatives are open in the sense that they are accessible to many people. But the openness is only one-way, i.e., the rest of the world cannot alter the "open" materials.

That is not necessarily a bad thing. Phenomena like Wikipedia not withstanding, I believe there is a role for materials that have authorship and authority. The Web facilitates their annotation, but not their underlying alteration. Even Wikipedia and the myriad of open-source software projects have found a need for governance. I relish the idea of everyone in the world annotating the ONC HIT curriculum, but I am less enthusiastic about everyone in the world updating the source materials.

Notwithstanding my concerns, I am excited to play a small role in the disruptive innovation of higher education through my own work. But I also know that MOOCs are not the complete solution. I envision a future where students are wedded to an educational institution, but have the flexibility of online learning and the ability to have some of their learning come from other teachers and institutions. Perhaps that is why initiatives like Semester Online, where 10 universities are sharing courses among each other, with appropriate transfers of academic credit and tuition money, will survive if MOOCs turn out to be a passing fad. We can probably learn from systems like the European Credit Transfer System (ETCS), which standardizes credits for higher education and allows their transfer across educational institutions.

I hope we can achieve a happy middle ground of making the best use of the dissemination and collaboration afforded by the Internet while still recognizing the value attachment to a real institution of higher learning. I also believe the cost of higher education can be reduced, but as former Harvard President Derek Bok used to say, If you think education is expensive, try ignorance.
This post by William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, appeared on his blog Informatics Professor, where he posts his thoughts on various topics related to biomedical and health informatics.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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